NCS000202_COMPLETE FILE - HISTORICAL_20191010

•----STORMWATER DIVISION CODING SHEET-.
RESCISSIONS .
PERMIT NO..
l� S O u v QU �(
N..
DOC'TYPE
COMPLETE FILE -HISTORICAL
DATE OF
.RESCISSION
YYYYMMDD

STORM EVENT CHARACTERISTICS:
Date5c Ap - 2. 6
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
N p FLO Vi !�
Mail Original and one copy to:
Division of Water Quality
Attn: Central riles
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
OCT 10 2019
CENTf;�gL FILES
DWR SEC7T1Otv
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best
of my knowledge and belirue, accurate, and complete. I am aware that there are significant penalties for submitting false information,
inclu 3ng _ e,putEsibiUty of floies and imprisonment for knowing violations."
of Pe
- 6
117#y
(Dat
Form SWU-246-1 12608
Page 2of2

Permit Number: NCS 000202
Certificate of Coverage Number: P
or
STORE#WATER DISCHARGE, OUTFALL (SDO)
MONTI'ORING REPORT
FACILITY NAME United States Gypsum Co.
PERSON COLLECTING SAMPLE(S)
CERTIFIED LABORATORY(S)
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 20 �� RJ(2V5 t
(This monitoring report shall be received by the Division no later than 30 days from
the dale the facility receives the sampling results from the laboratory.)
.Y M; Clell
O 828 765 - 9481
(S AT OF PERNTITTEE OR DESIGNEE)
By this sign• ture, 1 certify that this report is accurate
complete to the best of my knowledge.
Date
Sample
Collectedpp
I I
-
Total_
MM-Solids
Suspended
W=WW
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes `ono
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total Rainfall
Oil & Grease
Total
Suspended
Solids
pH
New Motor Oil
Usage
mo/dd/yr
MG
inches
m
m
Units
gaymo
Form S W U-246-1 12608
Page 1 of 2

e-
STORM EVENT CHARACTERISTICS:
Date A060T 210i
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
\\ , i 0
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh. North Carolina 27699-1617
RECEIVED
OCT 10 2019
rl CENTRAL FrILES
DWR SECTION
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or perso who manag a system, or those persons directly responsible for gathering the information, the information submitted is, to the best
nt k o dg and el ef, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
in lud p the oslibil' y bf fines and imprisonment for knowing violations."
(Signature
GDIf-7 I
(Date
Form SWU-246-112608
Page 2 of 2

Permit Number: NCS 000202
Certificate of Coverage Number: NCG
or
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
FACILITY NAME United States Gypsum Co.
PERSON COLLECTING SAMPLE(S)
CERTIFIED LABORATORY(S) Lab #
Lah #
1I
Part A: Specific Monitoring Requirements �\ V V �[ 0 FLOW
SAMPLES COLLECTED DURING CALENDAR YEAR: 20 i ` SE?TC KW 9
(This monitoring report shall be received by the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
C it hell
P ; 8 ) 765 - 9481
t
(S R . F PERMITTEE OR DESIGNEE)
By this signs e, I certify that this report is accurate
complete to the best of my knowledge.
Outtall
Date
No.
Sample
Collected
Total
Flow (if i
Total!
'
iZ.
JI
_
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes V no
(if ycs, complete Part B)
Part B. Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total Rainfall
Oil & Grease
Total
Suspended
Solids
pH
New Motor Oil
Usage
mo/dd/ •r
MG
inches
m
m
Units
gavmo
Form SWU-246-1 12608
Page 1 of 2